ORCID Profile
0000-0003-1124-6578
Current Organisations
University of Sydney
,
Royal Australasian College of Physicians
,
Children's Hospital at Westmead
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Health Promotion | Public Health and Health Services
Publisher: Wiley
Date: 10-2010
Publisher: BMJ
Date: 02-10-2018
DOI: 10.1136/ARCHDISCHILD-2018-315628
Abstract: Chronic conditions are the leading cause of mortality, morbidity and disability in children. However, children and caregivers are rarely involved in identifying research priorities, which may limit the value of research in supporting patient-centred practice and policy. To identify priorities of patients, caregivers and health professionals for research in childhood chronic conditions and describe the reason for their choices. An Australian paediatric hospital and health consumer organisations. Recruited participants (n=73) included patients aged 8 to 14 years with a chronic condition (n=3), parents/caregivers of children aged 0 to 18 years with a chronic condition (n=19), representatives from consumer organisations (n=13) and health professionals including clinicians, researches (n=38) identified and discussed research priorities. Transcripts were thematically analysed. Seventy-eight research questions were identified. Five themes underpinned participants’ priorities: maintaining a sense of normality (enabling participation in school, supporting social functioning, promoting understanding and acceptance), empowering self-management and partnership in care (overcoming communication barriers, gaining knowledge and skills, motivation for treatment adherence, making informed decisions, access and understanding of complementary and alternative therapies),strengthening ability to cope (learning to have a positive outlook, preparing for home care management, transitioning to adult services), broadening focus to family (supporting sibling well-being, parental resilience and financial loss, alleviating caregiver burden), and improving quality and scope of health and social care (readdressing variability and inequities, preventing disease complications and treatment side effects, identifying risk factors, improving long-term outcomes, harnessing technology, integrating multidisciplinary services). Research priorities identified by children, caregivers and health professionals emphasise a focus on life participation, psychosocial well-being, impact on family and quality of care. These priorities may be used by funding and policy organisations in establishing a paediatric research agenda.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2009
DOI: 10.1016/J.JURO.2009.08.060
Abstract: Although nocturnal enuresis is common in children, its etiology is multifactorial and not fully understood. We evaluated potential risk factors for presence and severity of nocturnal enuresis. A validated, reproducible questionnaire was distributed to 8,230 school children in Sydney, Australia. Nocturnal enuresis was defined as any wetting in the previous month and categorized as mild (1 to 6 nights), moderate (7 or more nights but less than nightly) or severe (nightly). Parents of 2,856 children (mean +/- SD age 7.3 +/- 1.3 years) completed the questionnaire (response rate 35%). Overall prevalence of nocturnal enuresis was 18.2%, with 12.3% of patients having mild, 2.5% moderate and 3.6% severe enuresis. Multivariate analysis showed that daytime incontinence (OR 4.8, 95% CI 2.9 to 7.9), encopresis (OR 2.7, 95% CI 1.6 to 4.4), bladder dysfunction (OR 3.6, 95% CI 2.4 to 5.3) and male gender (OR 2.0, 95% CI 1.3 to 3.1) were associated with severe nocturnal enuresis after adjustment for age. Emotional stressors (OR 2.3, 95% CI 1.2 to 4.2) and social concerns (OR 2.4, 95% CI 1.2 to 4.5) were associated with moderate nocturnal enuresis only. Encopresis and daytime incontinence are significant modifiable risk factors for nocturnal enuresis. Expressed as population attributable risk, 23% of nocturnal enuresis is associated with encopresis and daytime incontinence. Psychosocial factors appear to contribute to moderate but not severe nocturnal enuresis.
Publisher: Wiley
Date: 30-01-2023
DOI: 10.1111/JPC.16339
Abstract: To identify how the COVID‐19 pandemic influences parents' use of the internet, including social media, when seeking health‐related information about the pandemic relevant to their children. This study employed semi‐structured interviews to explore the factors affecting parents of young children when information‐seeking online about their children's health related to the COVID‐19 pandemic. Parents of children with and without chronic health conditions were interviewed in July and August 2020. Interviews were audio‐recorded and transcribed verbatim, then analysed using theoretical thematic analysis, based on Social Cognitive Theory. Through interviews with 13 parents, we identified a myriad of factors that affected parents' internet searching. The decision to access online health information and the regulation of its usage was multifaceted and relied upon the interactions between environmental triggers and parents' information needs, personal attitudes, and circumstances. Overall, parents felt supported by online health information during the COVID‐19 pandemic, and the majority were confident in their ability to navigate the plethora of online health information. However, parents of children with chronic conditions had unmet information needs in relation to COVID‐19 and their children's condition. Understanding parents' attitudes and behaviours when seeking online health information that is relevant to their children during a global pandemic can inform the optimisation of online health content delivery to parents.
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/JPC.14158
Abstract: Enuresis (bedwetting) is common in school-aged children and can impact health, psychosocial well-being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment-resistant enuresis from a multidisciplinary perspective. Causes of treatment resistance include lower urinary tract problems, constipation, incorrect alarm training techniques, sleep disorders including sleep apnoea and psychological comorbidities. Practical suggestions to address treatment resistance are offered utilising expertise from clinicians from different disciplines.
Publisher: Wiley
Date: 07-2013
DOI: 10.1111/IMJ.12193
Abstract: The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations.
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2016
Abstract: Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides. To describe stakeholder beliefs and experiences of conducting trials in children in LMICs. Electronic databases were searched to August 2014. Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs. Findingswere analyzed by using thematic synthesis. Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives’ pivotal role, managing expectations, and retaining involvement) cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust) contending with power differentials (exploitation, stigmatization, and disempowerment) translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism) and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits). Studies not published in English were excluded. Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/JPC.14918
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JPEDS.2017.11.031
Abstract: To conduct a systematic review of the evidence concerning whether and how adolescents search for online health information and the extent to which they appraise the credibility of information they retrieve. A systematic search of online databases (MEDLINE, EMBASE, PsycINFO, ERIC) was performed. Reference lists of included papers were searched manually for additional articles. Included were studies on whether and how adolescents searched for and appraised online health information, where adolescent participants were aged 13-18 years. Thematic analysis was used to synthesize the findings. Thirty-four studies met the inclusion criteria. In line with the research questions, 2 key concepts were identified within the papers: whether and how adolescents search for online health information, and the extent to which adolescents appraise online health information. Four themes were identified regarding whether and how adolescents search for online health information: use of search engines, difficulties in selecting appropriate search strings, barriers to searching, and absence of searching. Four themes emerged concerning the extent to which adolescents appraise the credibility of online health information: evaluation based on Web site name and reputation, evaluation based on first impression of Web site, evaluation of Web site content, and absence of a sophisticated appraisal strategy. Adolescents are aware of the varying quality of online health information. Strategies used by in iduals for searching and appraising online health information differ in their sophistication. It is important to develop resources to enhance search and appraisal skills and to collaborate with adolescents to ensure that such resources are appropriate for them.
Publisher: Elsevier BV
Date: 05-0017
DOI: 10.1067/MPD.2003.192
Abstract: To explore parents' attitudes to children's participation in randomized controlled trials. Qualitative analysis of focus group discussions involving 33 parents from a pediatric teaching hospital and local school in Australia. Parents varied in age, gender, ethnicity, level of education, research experience, and child's health status. The transcribed discussions were analyzed by theme linkage using the constant comparative method. Parents balance risks and benefits when deciding about trial participation for their child. Perceived benefits include the offer of hope, better care of their child, the opportunity to access new treatments, healthcare professionals and health information, meeting others in similar circumstances, and helping others. Perceived risks include potential side effects, being randomized to ineffective treatments, and the inconvenience of participation. The decision for trial participation is also influenced by parental factors (parents' knowledge, beliefs, and emotional responses), child factors (the child's health status and preference about participation), trial factors (the use of placebos and uncertainties of participation), and doctor factors (doctor's recommendations and communication of trial information). Educating parents about trials, improving communication between trialists, pediatricians, and parents, increasing incentives while decreasing inconveniences, and providing decision aids for parents may increase parents' willingness to participate in trials.
Publisher: Wiley
Date: 13-05-2004
Publisher: Wiley
Date: 05-12-2009
Publisher: Springer International Publishing
Date: 2016
Publisher: InTech
Date: 07-03-2012
DOI: 10.5772/29180
Publisher: Wiley
Date: 05-2013
DOI: 10.1111/IMJ.12119
Abstract: The first in a series of articles that demonstrate the practical aspects of telehealth, this paper provides three case studies that examine the suitability of telehealth for patients living in rural and remote areas who require ongoing specialist care.
Publisher: Wiley
Date: 07-2009
DOI: 10.1111/J.1440-1754.2009.01528.X
Abstract: Aim: (i) To determine the efficacy of bell and pad alarm therapy as an initial and relapse treatment for nocturnal enuresis (ii) to explore risk factors for treatment failure and (iii) to explore risk factors for relapse within 12 months of successful bell and pad alarm therapy. Methods: A 22‐item questionnaire was sent to 240 children who received bell and pad alarm therapy in a 6‐year period via a community centre. The questionnaire recorded demographic characteristics of the child, length of the first bell and pad alarm therapy, outcome of initial treatment and relapse information. Results: The initial response and relapse rates of bell and pad alarm therapy were 84 and 30%, respectively. Female gender, absence of diurnal symptoms and willingness to use alarm therapy were associated with better treatment outcomes. Treatment success was associated with shorter treatment length. The success rate of repeating alarm therapy after relapse was 78%, with an average length of treatment of 10 weeks. Conclusion: The bell and pad alarm therapy is an effective treatment for nocturnal enuresis both as initial therapy and after relapse. The association between patient characteristics and treatment response found in our study may help inform clinicians of likely treatment outcomes, and identify those who may need a different approach.
Publisher: Wiley
Date: 28-07-2015
DOI: 10.1111/IMJ.12835
Abstract: The recent trend to embed medical research at point of care has created a need for postgraduate research supervisors in hospitals who are practising clinicians and lab-based researchers. We explored the training needs of supervisors to inform the design and evaluation of a hospital-based development programme. We found that if hospital-based supervisors are to improve their practice, the programme needs to be on-site to ensure access and relevance to local issues.
Publisher: Wiley
Date: 13-04-2023
DOI: 10.1111/JPC.16387
Abstract: This study aimed to understand parents' online health information‐seeking behaviour and the potential influence of this on their relationship with their child's physician. A survey regarding parental online health information‐seeking behaviour was administered to parents of children aged under 18 years admitted to an Australian tertiary paediatric hospital, paediatric hospital ward and paediatric clinic, and in their social media networks. Responses were presented as frequencies and percentages. Associations between parents' trust in their child's doctor and survey responses were analysed using χ 2 tests. In all, 300 surveys were completed. Most parents (89%) reported searching for online health information when their child was sick. Some (31%) followed online health information instead of going to the doctor. Parents who trusted their child's doctor were more likely to follow the doctor instead of online health information when it contained conflicting advice. Most parents (91%) wanted health‐care professionals' help in searching for online health information. Almost all parents search for online health information, but most do not act on it. Parents' trust in their child's doctor influences how parents use online health information. Thus, clinicians could recommend trustworthy websites with information that complements their advice to ensure parents access reliable online health information.
Publisher: Therapeutic Guidelines Limited
Date: 12-2014
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.PRRV.2010.01.005
Abstract: Urinary incontinence has been found to be common in girls and women with cystic fibrosis (CF). This often can have a marked impact on daily activities and quality of life. It may also lead to potential deterioration of respiratory status due to reduced adherence to forced expiratory manoeuvres (cough, lung function tests and exercise) by the girls trying to avoid occurrence of urinary incontinence (UI). Analysis of the literature is limited by the fact that different definitions and a variety of questionnaires have been used. There is little literature regarding UI in men and boys which is thought to be less common than in females. National guideline recommendations in the management of CF in Australia and the United Kingdom have in recent years changed to incorporate screening and management of UI. No studies to date have looked at outcomes of interventions in children and adolescents with CF or other respiratory conditions however those working with this population need to be aware of the problem of UI as it is a treatable condition and could potentially be prevented.
Publisher: Wiley
Date: 29-11-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
DOI: 10.1016/J.JURO.2011.04.104
Abstract: We evaluated quality of life in children with urinary incontinence using a disease specific tool (Pediatric Incontinence Questionnaire) and determined factors that decrease quality of life in affected children. The Pediatric Incontinence Questionnaire was self-administered by children 6 to16 years old with urinary incontinence while attending outpatient clinics at a tertiary pediatric hospital in Australia between October 2009 and May 2010. A weighted summative quality of life score with a range of 1.75 to 7 (7 being lowest quality of life) was generated, and patient characteristics (age, gender, ethnicity, symptom severity) were evaluated as potential predictors. Of 146 children invited to participate 138 consented (response rate 95%). About half of the participants (77) were boys, and mean patient age was 10 years. Girls had a lower quality of life than boys (mean score 3.60 vs 3.31, 95% CI 0.10-0.57, p=0.04), and nonwhite children had a lower quality of life than white children (3.97 vs 3.35, 95% CI 0.23-0.99, p<0.01). Older age (r=0.21, p=0.01) but not increasing symptom severity (r=0.15, p=0.09) or underlying chronic disease (difference 0.12, p=0.91) was correlated to decreased quality of life. Multivariate regression analysis demonstrated that older age, nonwhite ethnicity and female gender were independent predictors of decreased quality of life. Older age, female gender and nonwhite ethnicity are associated with a lower disease specific quality of life in children with urinary incontinence. Clinicians need to be aware of the differential effect of urinary incontinence in children of different ages and ethnic backgrounds.
Publisher: Wiley
Date: 17-08-2010
DOI: 10.1111/J.1440-1754.2010.01823.X
Abstract: To explore consultant paediatricians' attitudes, motivations, and barriers to training medical students and junior doctors. Qualitative research involving 24 paediatricians (with a ersity of specialties, experience, age, gender, teaching activity and employment status) from a tertiary paediatric hospital and clinical school in Sydney, Australia. Participants were engaged in semi-structured focus group discussions which explored their attitudes to teaching medical students and junior doctors, their role and experience of teaching, their training in medical education, perceived barriers to teaching, and possible solutions to these barriers. Data from the transcriptions of the focus group discussions were coded using the constant comparative method and analysed for themes using NVivo 7 software. Differences in responses between participants were explored. All participants reported enjoying teaching. However, a number of factors which occurred at the consultant, learner and institution level affected the enjoyment or challenge of teaching. Consultant factors included time commitments, knowledge of and confidence in the learner's course, and comfort with teaching. Learner factors included level of knowledge, attendance, interest and enthusiasm, and cultural changes. Institution factors included acknowledgement of teaching contribution, communication, teaching support and resources, and attitude to teaching. These factors and the consultant's relationship with the learner and institution impacted on their ownership, involvement, and commitment to teaching. Consultant paediatricians identified challenges to their involvement and commitment to teaching. Actions to address these challenges and improve the relationship between the consultant and the learner and the consultant and the institution may enhance the consultant's commitment to teaching.
Publisher: Wiley
Date: 09-2011
DOI: 10.1111/J.1440-1754.2011.02166.X
Abstract: Paediatric research is essential for improving health outcomes of children. Waiting for adult studies before conducting paediatric studies will prolong the denial of effective treatment for children. If we rely on information from adult studies rather than conducting studies with children, we risk causing harm to children. In this paper, we identify and examine ethical issues unique to conducting research with children. These include the function and the value of a child's assent and the criteria that should guide a proxy in making decisions about a child's involvement in research, offering payment to children for research participation and acceptable levels of risk for paediatric research. Justice demands that children not be denied the benefits of research, and it is the role of the paediatric medical community to advocate not only for more research for children but also to ensure that the research conducted is of the highest quality.
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2016
Abstract: Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides. To describe stakeholder beliefs and experiences of conducting trials in children in LMICs. Electronic databases were searched to August 2014. Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs. Findingswere analyzed by using thematic synthesis. Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives’ pivotal role, managing expectations, and retaining involvement) cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust) contending with power differentials (exploitation, stigmatization, and disempowerment) translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism) and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits). Studies not published in English were excluded. Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.
Publisher: BMJ
Date: 11-2018
DOI: 10.1136/BMJPO-2018-000369
Abstract: We evaluated 300 paediatric trials to determine: the consent and recruitment strategies used, who trial information was targeted to, how incentives were used and if they achieved their recruitment targets. For this cross-sectional evaluation, we searched the Cochrane Central Register of Controlled Trials for paediatric trials published in 2012 and randomly selected 300 that reported on outcomes for participants aged ≤21 years. We collected data on consent and recruitment procedures for each trial and undertook descriptive analyses in SPSS statistics V.23. All but one trial (99.7%) used a standard recruitment strategy. Most (92%) trials reported that consent was obtained but only 13% reported who obtained consent. Two-thirds (65%) of trials included school-aged participants, and of these 68% reported obtaining assent. Half (50%) of the trials reported who the trial information was targeted to. Most trials (75%) of school-aged participants targeted information towards children or children and their parents. Fourteen per cent of trials reported using incentives, half (50%) of which were in the form of compensation. Only 48% of trials reported sufficient data to determine if their recruitment targets were achieved. Of these, 70% achieved their targets. Notable reporting shortcomings included: how families were recruited into the trial, who obtained consent and/or assent and how, who trial information was directed to, whether incentives were used and sufficient data to determine if the recruitment target was achieved. Forthcoming paediatric-specific reporting standards may improve reporting in this priority area. Our data provide a baseline for ongoing monitoring of the state of the research.
Publisher: Wiley
Date: 02-01-2018
DOI: 10.1111/JPC.13834
Abstract: To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years. Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 years or over were included. Consultations in each cohort (2008 and 2013) categorised as either listing or not listing enuresis. Characteristics of the 'enuresis' versus 'non-enuresis' subgroup in each cohort were compared as were the enuresis subgroups 2008 versus 2013. Of 4175 and 4181 consultations in 2008 and 2013, enuresis was reported in 178 (4.3% - 2008) and 193 (4.6% - 2013). Constipation and encopresis were more prevalent in the enuresis versus non-enuresis subgroups (46 (25.8%) vs. 136 (3.4%) for constipation and 25 (14%) vs. 65 (1.6%) for encopresis in 2008 52 (26.9%) vs. 160 (4%) for constipation and 25 (13%) vs. 78 (2%) for encopresis in 2013, both P < 0.001). The enuresis subgroup had more referrals to multidisciplinary teams (19 (10.7%) vs. 148 (3.7%) - 2008 and 21 (10.9%) vs. 163 (4.1%) - 2013, both P < 0.001) and allied health professionals (29 (16.3%) vs. 230 (5.8%) - 2008 27 (14%) vs. 178 (4.5%) - 2013, both P < 0.001). The overall frequency of presentation of children for management of enuresis was low. Prevalence/Consultation characteristics of enuresis were comparable over 5 years. Constipation and encopresis were significantly more prevalent in the enuresis subgroups.
Publisher: Wiley
Date: 22-03-2016
DOI: 10.1111/TCT.12464
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/JPC.15613
Abstract: Nocturnal enuresis (NE) and sleep‐disordered breathing (SDB) are common in childhood. While the two disorders are linked, those links are still being clarified. This study compared sleep profiles and enuresis‐related behaviours between children with NE and those without, who were referred to a tertiary sleep unit with suspected SDB, using the combination of polysomnography (PSG) and questionnaire. Continuous numerical data were analysed after adjusting for body mass index z ‐score. The study included 52 Children (39 boys, 13 girls) aged 5–14 years. Twenty‐one had enuresis (10 monosymptomatic enuresis (MNE) and 11 non‐monosymptomatic enuresis (NMNE)) and 31 did not have enuresis. The majority had comorbidities. On PSG, all children with NE had moderate obstructive sleep apnoea (OSA) compared to the control group which were of mild OSA. Children with NMNE had a higher percentage time in stage‐3 non‐REM sleep when compared to the non‐enuretic and MNE groups ( P 0.05). On the questionnaire, more parents of the NE groups reported that their child was ‘difficult to wake in the morning’ ( P 0.05). In this heterogeneous population referred for suspected SDB, children with NE had moderate OSA, yet those with MNE had increased arousals and more often report difficulty waking than children with suspected SDB who do not wet, while children with NMNE exhibit changes in sleep architecture suggesting deeper sleep. These differences may impact treatment choices for children with enuresis.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2018
Publisher: IGI Global
Date: 2016
DOI: 10.4018/978-1-4666-9522-1.CH004
Abstract: This chapter looks at how gamification of existing technology can be used to incorporate the factors that have been found to improve patient adherence. Lack of adherence to medical advice is a major problem because it reduces the likelihood of improved health outcomes and is a waste of costly and scarce resources. To provide intrinsically motivating game mechanics we discuss the use of an embodied virtual character to build an ongoing therapeutic alliance with the patient. Extrinsically motivating game mechanics are added via a game based on the token economy. The intention is to empower, engage and encourage the patient to adhere with the medical advice. A case study is provided for the condition of paediatric incontinence.
Publisher: Wiley
Date: 11-2018
DOI: 10.1111/JPC.14203
Publisher: SAGE Publications
Date: 25-07-2012
Abstract: Low participation rates in randomised controlled trials involving children are almost a universal problem, leading to high cost and low statistical power. Trial, parent/family, child, and physician factors have been reported to influence parental willingness to consent for paediatric trials. To identify modifiable and unmodifiable factors associated with parental consent. Demographic and clinical characteristics of children and their families and physician characteristics associated with parental consent were evaluated in a recent randomised placebo-controlled trial of prophylactic antibiotics to prevent recurrent urinary tract infection. Of 1109 eligible children identified (mean age, 2.0 years), 412 parents (37.2%) consented. On a multivariate analysis, the only modifiable factor associated with consent was request for consent by a member of the research study team rather than by a member of the clinical team (risk ratio (RR) = 1.9, 95% confidence interval (CI): 1.2–2.9). The unmodifiable factors significantly associated with consent were age of the child (≥4 years) (RR = 1.2, 95% CI: 1.1–1.4), presence of vesicoureteric reflux (RR = 1.5, 95% CI: 1.3–1.8), inpatient management of the index infection (RR = 0.8, 95% CI: 0.7–0.9), and multiple (≥4) symptoms at presentation (RR = 1.3, 95% CI: 1.1–1.5). We have reported data from only one of the four participating centres in this trial. Data on non-consenters in other participating centres were not completely collected. Data on characteristics of the recruiting physician were limited. These findings are applicable for those considering a single randomised controlled trial. Parent, child, and physician factors are associated with consent for trial participation, with most not being modifiable. Having a member of the research study team approach the parent for consent appears to be the only feasible strategy for increasing recruitment to randomised trials in this setting.
Publisher: Public Library of Science (PLoS)
Date: 09-11-2010
Publisher: ACM
Date: 02-12-2014
Publisher: Wiley
Date: 16-08-2012
DOI: 10.1111/J.1440-1754.2012.02522.X
Abstract: Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students.
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/IMJ.13351
Abstract: Increasing the amount of clinical research that occurs in healthcare settings has been identified as an important mechanism to improve healthcare outcomes. While clinicians are key persons in achieving this aim, research participation amongst clinicians is generally limited. To identify the factors (barriers and facilitators) influencing clinician research participation and determine how professional culture impacts on these factors. Forty clinicians working at a tertiary children's hospital participated in six discipline-specific focus groups. Thematic analysis was performed using an inductive process based in grounded theory. Four major themes (cultural factors, personal factors, resources and solutions) and 16 subthemes were identified. Participants described how the current health system discourages clinician research. They reported that their research participation requires personal sacrifice of their own time income or career progression. Research participation was seen to compete with other priorities in clinicians' workload and is disadvantaged because of the primacy of clinical work and the lack of immediate tangible benefit from research projects. Solutions suggested by our participants included better alignment of clinical and research goals, improved availability of research mentors and collaborative opportunities. Nurses and allied health professionals reported a changing professional culture that values research. Only doctors identified research participation to be important for career progression. For clinician research participation to flourish, significant changes in healthcare structure and priorities will be required that result in research becoming more embedded in healthcare delivery. Initiatives to improve collaboration between clinicians and universities may also support these aims.
Publisher: Wiley
Date: 10-2013
DOI: 10.1111/IMJ.12264
Abstract: The third in a series of articles about the practical aspects of telehealth, this paper gives guidance on suitable setup for video consultations, including layout of rooms, managing sound and image quality, scheduling, testing and best practice in telehealth videoconferencing.
Publisher: Springer International Publishing
Date: 2017
Publisher: Elsevier BV
Date: 12-2002
Abstract: To examine pediatricians' attitudes toward children's participation in randomized controlled trials (RCTs) and identify possible barriers to participation. Qualitative analysis of focus group discussions involving 16 pediatricians and 5 trainees from a pediatric teaching hospital in Australia. Doctors varied in occupation, experience, research activity, age, sex, ethnicity, and parenthood experience. A professional facilitator conducted the semistructured group discussions. The transcribed audiotapes were analyzed by theme linkage by using the constant comparative method. Pediatricians believed parents balanced perceived gains and risks when deciding about trial participation. They thought the child's condition, parents' health beliefs and personal attributes, and the doctors' beliefs and relationship with the investigators influenced parents' attitudes. Perceived gains included professional benefits for pediatricians, improved patient care, convenience for the families and themselves, and scientific advancement. Perceived risks included inconvenience, inadequate resources, and potential harms to the patient and doctor-patient relationship. Pediatricians with previous research experience were most knowledgeable about RCTs and perceived greatest gains from trial participation. Pediatricians' personal treatment preferences hindered trial support. This study suggests that children's participation in trials will be enhanced by increasing pediatricians' awareness of RCTs through education and involvement in trials and by improving the gains-risk balance.
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2015
Abstract: Treatments and interventions used to care for children in emergencies should be based on strong evidence. Well-designed clinical trials investigating these interventions for children are therefore indispensable. Parental informed consent is a key ethical requirement for the enrollment of children in such studies. However, if time is limited because of an urgent need for intervention, there are additional ethical challenges to adequately support the informed consent process. The acute situation and associated psychological impact may compromise the ability of parents to give informed consent. Little evidence exists to guide the process of consent seeking for a child’s research participation when time is limited. It is also unclear in what circumstances alternatives to prospective informed consent could be applied. This article describes possible options to manage the informed consent process in an appropriate, practical, and, we believe, ethical way when time is limited.
Publisher: Wiley
Date: 29-07-2012
DOI: 10.1111/J.1440-1754.2012.02503.X
Abstract: The busy clinician is constantly faced with clinical questions regarding patient care. It is easy to feel overwhelmed by the large amount of health information available electronically. This article offers one easy approach for searching the electronic database. It is intended for the busy clinician who is unsure how to conduct an electronic search. It provides guidance on where to search and how to search using the PICO search method. It also provides a list of useful resources to help clinicians critically appraise the articles found to determine its relevance.
Publisher: Wiley
Date: 12-2010
Publisher: Elsevier BV
Date: 05-2023
Publisher: Springer Science and Business Media LLC
Date: 04-2012
DOI: 10.2165/11594870-000000000-00000
Abstract: Nocturnal enuresis, or bedwetting, is the most common cause of urinary incontinence in children. It is known to have a significant psychosocial impact on the child as well as the family. Nocturnal enuresis typically presents as failure to become dry at night after successful daytime toilet training. It can be primary or secondary (developing after being successfully dry at night for at least 6 months). Children with nocturnal enuresis may have excessive nocturnal urine production, poor sleep arousal and/or reduced bladder capacity. Alarm therapy is the recommended first-line therapy, with treatment choices being influenced by the presence or absence of the abnormalities mentioned above. Children with nocturnal enuresis may also have daytime urinary urgency, frequency or incontinence of urine. This group (non-monosymptomatic nocturnal enuresis) requires a different clinical approach, with a focus on treating daytime bladder symptoms, which commonly involves pharmacotherapy with anticholinergic medications and urotherapy (including addressing bowel problems). This review discusses the current management of nocturnal enuresis using the terminologies recommended by the International Children's Continence Society.
Publisher: Wiley
Date: 22-07-2005
DOI: 10.1111/J.1365-2753.2005.00596.X
Abstract: To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice. Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation. We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in in idual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice.
Publisher: Wiley
Date: 31-07-2019
DOI: 10.1111/JPC.14575
Publisher: Wiley
Date: 16-10-2019
DOI: 10.1111/JPC.14256
Abstract: To explore associations between weight and type/frequency of urinary incontinence (UI) in children presenting to a tertiary hospital incontinence clinic. We retrospectively reviewed medical records of children who first attended the incontinence clinic at The Children's Hospital at Westmead between January 2004 and December 2014. A random s le of 1000 children was selected from 2022 patient records, and data were collected on weight, height, age, gender, UI parameters, bowel habits and medical history. Associations between predictors (weight categories, gender, snoring, constipation, faecal incontinence) and outcomes (daytime urinary incontinence (DUI) and nocturnal enuresis (NE)) were examined using χ A total of 862 children were included in the study 54% were male, and 28% were overweight/obese. No evidence of difference was found between the underweight/normal and overweight/obese weight children with NE (34 vs. 39%), DUI (7 vs. 9%) or combined NE and DUI (58 vs. 52.1%), P = 0.23. The frequency of NE (83 vs. 82%, P = 0.56) and DUI (52 vs. 58%, P = 0.20) was similar between the weight groups. In a large cohort of children presenting to a tertiary incontinence clinic, weight was not associated with the type or frequency of UI.
Publisher: Springer Science and Business Media LLC
Date: 20-10-2022
Publisher: Wiley
Date: 19-10-2021
DOI: 10.1111/JPC.15222
Publisher: Wiley
Date: 25-08-2010
DOI: 10.1111/J.1440-1754.2010.01821.X
Abstract: To assess the accuracy of brief parental questionnaire reporting of daytime bladder symptoms in children with nocturnal enuresis and compare with in-depth reporting elicited by physician assessment, for diagnosing monosymptomatic and non-monosymptomatic nocturnal enuresis. A cross-sectional study of consecutive children attending an outpatient nocturnal enuresis clinic at a tertiary paediatric hospital participated in the study. Parents were asked to complete a questionnaire as part of routine assessment at their first visit which was compared with a detailed clinical assessment by the physician involving eliciting a thorough history from the parent and child. Parents of 585 children participated in the study (mean age 9.2 years, range 5.0-17.5 years). Sixty percent of children were males. There was poor agreement between initial parental reporting and physician diagnosis of monosymptomatic and non-monosymptomatic nocturnal enuresis (Kappa = 0.3, 95% confidence interval 0.21-0.37), mainly because parents underreport daytime incontinence and urgency compared with physician-elicited information (43% vs. 69% and 66% vs. 87%, respectively). Parents underreport daytime symptoms by 20-25%. Reliance on a brief parental history without prompting by physicians for daytime symptoms for diagnosing type of nocturnal enuresis may be misleading and result in suboptimal management.
Publisher: IGI Global
DOI: 10.4018/978-1-5225-1928-7.CH005
Abstract: This chapter looks at how gamification of existing technology can be used to incorporate the factors that have been found to improve patient adherence. Lack of adherence to medical advice is a major problem because it reduces the likelihood of improved health outcomes and is a waste of costly and scarce resources. To provide intrinsically motivating game mechanics we discuss the use of an embodied virtual character to build an ongoing therapeutic alliance with the patient. Extrinsically motivating game mechanics are added via a game based on the token economy. The intention is to empower, engage and encourage the patient to adhere with the medical advice. A case study is provided for the condition of paediatric incontinence.
Publisher: AMPCo
Date: 08-2015
DOI: 10.5694/MJA15.00189
Abstract: To generate a contemporary understanding of "teaching by humiliation" as experienced by medical students in Australia. In this pilot study, we surveyed final-stage medical students from two Australian medical schools about their experiences of teaching by humiliation during their adult and paediatric clinical rotations. The students were invited to complete the anonymous survey at the end of their paediatric rotation in Semester 2 of 2013. We used descriptive statistics to analyse quantitative data, and a grounded theory approach to analyse qualitative data. Student reports of experiencing or witnessing teaching by humiliation during their adult and paediatric clinical rotations. Of 151 students invited to participate, 146 (96.7%) completed the survey. Most students reported experiencing (108 74.0%) or witnessing (118 83.1%) teaching by humiliation during adult clinical rotations. Smaller but still sizeable proportions had experienced (42 28.8%) or witnessed (64 45.1%) it during their paediatric clinical rotation. The humiliating and intimidating behaviours students experienced were mostly more subtle than overt and included aggressive and abusive questioning techniques. The students' responses to these practices ranged from disgust and regret about entering the medical profession to endorsement of teachers' public exposure of a student's poor knowledge. Practices associated with humiliating medical students persist in contemporary medical education. These practices need to be eradicated, given the evidence that they affect students' learning and mental health and are dissonant with formal professionalism curricula. Interventions are needed to interrupt the transgenerational legacy and culture in which teaching by humiliation is perpetuated.
Publisher: Wiley
Date: 20-01-2016
Publisher: Informa UK Limited
Date: 17-08-2020
Publisher: BMJ
Date: 11-04-2018
DOI: 10.1136/ARCHDISCHILD-2017-314631
Abstract: To evaluate research priority setting approaches in childhood chronic diseases and to describe the priorities of stakeholders including patients, caregivers/families and health professionals. We conducted a systematic review of MEDLINE, Embase, PsycINFO and CINAHL from inception to 16 October 2016. Studies that elicited stakeholder priorities for paediatric chronic disease research were eligible for inclusion. Data on the prioritisation process were extracted using an appraisal checklist. Generated priorities were collated into common topic areas. We identified 83 studies (n=15 722). Twenty (24%) studies involved parents/caregivers and four (5%) children. The top three health areas were cancer (11%), neurology (8%) and endocrine/metabolism (8%). Priority topic areas were treatment (78%), disease trajectory (48%), quality of life sychosocial impact (48%), disease onset revention (43%), knowledge/self-management (33%), prevalence (30%), diagnostic methods (28%), access to healthcare (25%) and transition to adulthood (12%). The methods included workshops, Delphi techniques, surveys and focus groups/interviews. Specific methods for collecting and prioritising research topics were described in only 60% of studies. Most reviewed studies were conducted in high-income nations. Research priority setting activities in paediatric chronic disease cover many discipline areas and have elicited a broad range of topics. However, child/caregiver involvement is uncommon, and the methods often lack clarity. A systematic and explicit process that involves patients and families in partnership may help to inform a more patient and family-relevant research agenda in paediatric chronic disease.
Publisher: Wiley
Date: 04-05-2020
DOI: 10.1111/JPC.14853
Publisher: Wiley
Date: 25-01-2018
DOI: 10.1111/TCT.12753
Abstract: Paediatric incontinence has traditionally been managed through a discipline-specific approach by doctors, nurses, physiotherapists and psychologists. We evaluated a workshop aiming to increase health professionals' knowledge, confidence and willingness to involve other health professionals when managing paediatric incontinence. Our 1-day workshop focused on paediatric bedwetting, daytime incontinence, faecal incontinence and neurogenic bladder. Attendees completed surveys before and after the workshop, and 6 months later. Differences between health professionals and changes in attitudes, knowledge, confidence and experience before and after the workshop were analysed using descriptive analysis. Qualitative data analysis was undertaken using content analysis. The workshop was attended by 77 clinicians (41 doctors, 19 allied health professionals and 17 nurses). Over two-thirds of respondents acknowledged having average or above average knowledge of and/or confidence in managing bedwetting, daytime urinary incontinence (DUI) and faecal incontinence, with lower baseline knowledge and confidence for neurogenic bladder. Participants who completed the initial and final surveys reported increased knowledge, improved ability to manage patients, better appreciation of the contribution of other disciplines and willingness to refer patients to other disciplines. Of those who saw patients with incontinence, most reported that the workshop had improved their management: 33/35 for bedwetting 31/35 for DUI 21/29 for faecal incontinence and 16/19 for neurogenic bladder. Paediatric incontinence has traditionally been managed through a discipline-specific approach by doctors, nurses, physiotherapists and psychologists DISCUSSION: This study demonstrates that an interprofessional workshop conducted by clinicians from different health professional backgrounds increases clinicians' awareness of the roles of other disciplines and promotes the development of an interdisciplinary approach or multiprofessional collaboration, enabling a more effective, patient-centred, collaborative care model.
Publisher: Wiley
Date: 14-09-2008
DOI: 10.1111/J.1440-1754.2007.01207.X
Abstract: Aims: To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation. Methods: A prospective cross‐sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child’s bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation. Results: Of the 277 participants aged 4.8–17.5 years (median 8.6 years), 36.1% ( n = 95) were identified as constipated by the clinician‐based scoring method (‘Constipation Score’) compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency. Conclusions: Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
Publisher: Wiley
Date: 2014
DOI: 10.1111/IMJ.12330
Abstract: Despite a drive to increase research in healthcare settings, clinician participation in research remains infrequent. This paper describes an online survey comparing attitudes with research participation among clinicians (doctors, nurses and allied health professionals) at an Australian tertiary children's hospital. Differences between professional groups support the existence of different professional cultures surrounding research, suggesting that multiple strategies are required to improve participation in research.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2022
DOI: 10.1186/S12889-022-13599-7
Abstract: The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires critical health literacy to discriminate between sources, critically analyse meaning and relevance, and use information for personal health. Adolescents with poor digital health literacy risk using misinformation, with potential negative health outcomes. We aimed to understand adolescents’ contemporary digital health literacy and compared self-efficacy with capability. Adolescents (12–17 years) completed an eHEALS self-report digital health literacy measure, a practical search task using a think-aloud protocol and an interview to capture perceived and actual digital health literacy. eHEALS scores were generated using descriptive statistics, search tasks were analysed using an observation checklist and interviews were thematically analysed based on Social Cognitive Theory, focussing on self-efficacy. Twenty-one participants generally had high self-efficacy using online health information but perceived their digital health literacy to be higher than demonstrated. They accessed online health information unintentionally on social media and intentionally via search engines. They appraised information medium, source and content using general internet searching heuristics taught at school. Information on social media was considered less trustworthy than websites, but participants used similar appraisal strategies for both some search/appraisal heuristics were insufficiently nuanced for digital health information, sometimes resulting in misplaced trust or diminished self-efficacy. Participants felt anxious or relieved after finding online health information, depending on content, understanding and satisfaction. They did not act on information without parental and/or health professional advice. They rarely discussed findings with health professionals but would welcome discussions and learning how to find and appraise online health information. Whilst adolescents possess many important digital health literacy skills and generally feel self-efficacious in using them, their critical health literacy needs improving. Adolescents desire increased digital health literacy so they can confidently appraise health information they find online and on social media. Co-designed educational interventions with adolescents and health providers are required.
Publisher: Wiley
Date: 02-2014
DOI: 10.1111/IMJ.12339
Abstract: The fifth in a series of papers on practical aspects of telehealth, this paper discusses telehealth models that can facilitate the provision of specialist services to rural and remote patients closer to home. Some of the barriers to successful implementation of these models relates to workforce, funding and infrastructure at rural sites, as well as the traditional mindset of healthcare professionals. Therefore, the rural sector needs to be adequately resourced for telehealth models to be substantive and successful. This paper describes the development of a large teleoncology network over a vast geographical area in North Queensland. Adequate resourcing for the rural sites and undertaking quality improvement activities has continually enhanced the model over a 5- to 6-year period. The benefits of this model of care are twofold: (i) patients received their care closer to home and (ii) the workforce, service capabilities and infrastructure for the hospital in Mt Isa (a rural town 900 km away from its tertiary centre) has improved.
Publisher: Wiley
Date: 04-06-2018
DOI: 10.1111/JPC.14068
Abstract: The internet has enabled parents to become informed medical consumers and take an active role in their child's treatment. We aimed to determine parents' online medical information-seeking behaviour about their child's health. This included sources of information, reasons for searching, use and assessment of information and whether parents wanted assistance with searching and assessing information. A questionnaire was distributed to 331 parents and carers of inpatients and outpatients at Children's Hospital at Westmead in 2015. Most questions involved tick-box responses and a few free-text responses. Responses were tabulated and described by frequencies and percentages. Associations between participant demographics and responses were examined using chi-square tests. In all, 308 (93%) questionnaires were returned. Most participants (90%) reported searching for medical information about their child's health. Of these, 96% searched the internet, and of these, 63% used a smartphone. The most common reason for searching before seeing the doctor was to prepare questions. The most common reasons for searching after seeing the doctor were to know more and because participants had more questions. Only half (57%) ascertained whether an information source was reliable. Most wanted guidance on searching (69%) and assessing reliability (77%). Almost all parents search for online information about their child's health, but most are unsure whether the information they find is trustworthy and are hesitant to act on or present it to their child's doctor. Health professionals could discuss this with parents during consultations to dispel potential misunderstandings and provide guidance on searching and assessing.
Publisher: Wiley
Date: 30-08-2019
DOI: 10.1111/JPC.14189
Abstract: Studies of published clinical trials involving children have shown frequent omissions in key aspects of design and conduct, but these problems may be artefactual and due to editorial processes and space limitations. To determine actual design and conduct, we analysed the completeness of key domains in trial protocols involving children submitted to Human Research Ethics Committees. The ethics committees of all eight children's hospitals in Australia were invited to participate. De-identified trial protocols submitted for review in 2012 were evaluated using a checklist derived from Consolidated Standards of Reporting Trials, the Cochrane Risk of Bias Tool and Good Clinical Practice guidelines. Four ethics committees agreed to participate, and 69 protocols were analysed. The domains almost always reported were clustered around the background and trial plan (planned interventions for each group (99%), specific objectives (97%) and scientific background (96%)). Risk-of-bias domains such as random sequence generation and blinding of participants were often reported (75-90%). Domains least reported were clustered around the statistical analysis plan (66%), specified intention-to-treat analysis (54%), the justification for the proposed trial based upon a systematic review (48%) and age-specific outcomes (48%). Protocols of trials involving children assessed by ethics committees generally include details on background and basic design, but many key domains in trial design and conduct are not covered. Despite widespread recognition of how problems in the design and conduct of trials may lead to unreliable results, investigators still appear to be omitting key elements in trial protocols.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2015
Publisher: Wiley
Date: 25-06-2021
DOI: 10.1111/JPC.15631
Abstract: Giggle incontinence is a distinct entity of childhood daytime urinary incontinence (DUI), where children wet themselves only when they laugh. The prevalence of true giggle incontinence is unknown, with confusion about the diagnosis of urinary incontinence occurring during laughter and true giggle incontinence. The aim of the study is to improve our understanding of urinary incontinence during laughter by comparing those children with children who have DUI at other times, but not with laughter. We conducted a retrospective medical record review of children with DUI who presented to a tertiary continence service from 2017 to 2018, collecting data on age, gender, associated comorbidities, lower urinary tract symptoms, investigations, provisional diagnosis at first visit and initial treatment responses. Differences between those with DUI occurring during laughter and those with DUI at other times, but not with laughter were compared using standard statistical methods. Of the 277 new patients seen during the study period, 140 (51%) had DUI, and of these, 72 (51%) had DUI occurring during laughter. Children with incontinence occurring during laughter were more likely to have incontinence associated with other activities. One child had giggle incontinence according to the International Children's Continence Society's definition. Four other children were referred specifically for urinary incontinence associated with laughter, with the term giggle incontinence sometimes used by the referring doctor. Children with DUI commonly experience incontinence during laughter, but true giggle incontinence is rare. Correct diagnosis is essential as it directs treatment.
Publisher: Massachusetts Medical Society
Date: 29-10-2009
Publisher: Wiley
Date: 03-11-2012
DOI: 10.1111/J.1440-1754.2011.02216.X
Abstract: Lower urinary tract symptoms, particularly urgency, frequency and incontinence are common in school-aged children but are often overlooked. They may cause considerable physical, social and psychological difficulties to children and their families, and usually are manifestations of underlying non-neurogenic voiding disorders. The differential diagnoses include overactive bladder syndrome, dysfunctional voiding and vaginal reflux as well as less common conditions like giggle incontinence, voiding postponement, pollakiuria and diabetes insipidus. In this paper, we discuss an evidence-based approach to the management of conditions causing daytime urinary incontinence and lower urinary tract symptoms in children from a general paediatrician's perspective.
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2012
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2012
Publisher: Elsevier BV
Date: 06-2018
Publisher: Wiley
Date: 2014
DOI: 10.1111/IMJ.12323
Abstract: The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.
Publisher: Wiley
Date: 06-04-2017
DOI: 10.1111/JPC.13537
Abstract: The aim of this study was to determine whether there is a match between the health problems that children face and the clinical trials that are being conducted, especially in low- and middle-income countries (LMICs). All trials on the World Health Organisation International Clinical Trials Registry Platform registered from 2005 to 2013 were reviewed. The disease-specific focus of registered trials for children was compared to the global burden of disease for 2011 using World Health Organisation disability-adjusted life-year data. Children account for 34% of the global disease burden, but were represented in only 15% (29 899/203 726) of registered trials. Although the number of trials in children registered annually has increased over time (from 3174 in 2005 to 3392 in 2013), the proportion of trials involving children has decreased (from 18 to 13%). LMICs account for 98% of the disease burden among children world-wide, but only 22% of trials. More trials were registered in high-income countries than in LMICs for the majority of the disease categories. There was moderate correlation between the number of trials and the burden of each disease within each region (Spearman's correlation r = 0.6, P = 0.007 and r = 0.55, P = 0.02 in LMICs and high-income countries, respectively). Overall, children continue to be under-represented in clinical trials, particularly children from LMICs where disease burden is greatest. Clinical trial activity correlates moderately with disease burden among the world's children. A more evidence-informed approach for prioritising trials to specifically address the health-care needs of children is required.
Publisher: Wiley
Date: 12-12-2012
Publisher: Elsevier BV
Date: 08-2004
Publisher: BMJ
Date: 08-12-2015
DOI: 10.1136/ARCHDISCHILD-2015-308564
Abstract: To compare a novel code-word alarm with a commercially available wireless alarm for treating enuresis. A tertiary paediatric centre. Children aged 6–18 with at least 3 wet nights per week in the previous 6 months referred by doctors. Primary outcome: the proportion who achieved a full response (14 consecutive dry nights) by 16 weeks. Secondary outcomes: change in frequency of wetting, duration of alarm training, percentage of wet nights that the child woke to the alarm, adherence to treatment, adverse events and satisfaction with treatment. Of the 353 participants, 176 were assigned to the code-word alarm and 177 to control. At 16 weeks, 54% (95% CI 47% to 61%) in the experimental group and 47% (95% CI 40% to 55%) in the control group had achieved a full response (p=0.22), with 74% and 66%, respectively, attaining a 50% or more reduction in wetting frequency (p=0.14). The experimental group woke more often than the control group (median percentage of waking 88% vs 77%, p=0.003) and had a greater reduction in wet nights (median reduction of 10 vs 9 nights per fortnight). Fewer in the experimental group discontinued therapy before achieving a full response (27% vs 37% discontinued, p=0.04). There were no significant differences in relapse rates at 6 months, adverse events or satisfaction between the two alarms. Although the code-word alarm increased waking, no difference in full response rates was demonstrated between the two alarms. ACTRN12609000070235.
Publisher: IEEE
Date: 10-2018
Publisher: Wiley
Date: 19-07-2013
Publisher: Wiley
Date: 18-06-2015
DOI: 10.1111/TCT.12287
Abstract: The approaches used to educate future clinicians must be continually improved through evidence-based methods. Clinicians interested in conducting education research need to understand the terminology and conventions of health professional education, in the same way that health professional educators from education backgrounds need to be aware of clinical practices and scientific mores and jargon. This article provides clinicians with 10 steps to conducting health professional education research, and encourages collaboration between clinicians interested in education and health professional educators. The basic steps in conducting education research are introduced, beginning with literature searches, using appropriate terminology and writing conventions, and finding research collaborators. We encourage researchers to ask themselves, 'So what?' about their research idea to ensure it is interesting and relevant to a journal's readers. The nuts and bolts of educational research are then presented, including research questions and methodologies, outcome measures, theoretical frameworks and epistemologies. The final two steps aim to foster internationally relevant and well-designed research studies. Conducting and publishing education research is often difficult for clinicians, who struggle with what is required. Yet clinicians who teach are ideally placed to identify the knowledge gaps about how we can more effectively educate future clinicians. These 10 steps provide clinicians with guidance on how to conduct education research so relevant research findings can inform the education of future clinicians. Conducting and publishing education research is often difficult for clinicians.
Publisher: Wiley
Date: 19-07-2023
DOI: 10.1111/IMJ.16168
Abstract: Systematic reviews provide the highest level of evidence about a topic. Ten‐week workshops in conducting systematic reviews were held with hospital doctors in 2019 and 2020. This study analysed participants' feedback about the systematic review workshops to improve how we teach clinicians about conducting systematic reviews. Attendees completed a post‐workshop survey (with multiple‐choice and free‐text items) to assess knowledge and skills gained. We compared the responses of senior and junior doctors. We used descriptive statistics for the quantitative data and compared groups using Χ 2 testing. Qualitative data were analysed using conceptual content analysis. Of 81 attendees, 52% completed the survey. Of those, 69% had no prior experience with systematic reviews, 93% reported increased knowledge and ability to conduct research and 69% reported increased ability to conduct systematic reviews. More senior than junior clinicians reported gaining knowledge about writing and publishing (37% vs 11%, P = 0.047) and making greater use of skills gained to conduct research (56% vs 23%, P = 0.029). Five themes were identified: learning through course structure learning through course organisation teaching style flexible learning and suggestions for progression and improvement. Respondents suggested running the workshops during protected teaching time, more time for some sessions, conducting the workshop series more often and making clinicians aware of the workshop series at hospital orientation. The skills learnt from the systematic review workshop series impacted not only participants' research knowledge and skills, and plans to conduct future research, but also facilitated looking up medical literature in daily clinical work, supporting evidence‐based clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2018
DOI: 10.1007/S00467-017-3830-1
Abstract: Enuresis (intermittent urinary incontinence during sleep in a child aged ≥ 5 years) is commonly seen in paediatric practice. Despite the availability of effective interventions, treatment resistance is encountered in up to 50% of children. In this educational review we attempt to provide insight into the causes of treatment resistance, and offer practical suggestions for addressing this condition using an interprofessional approach. We explore the pathophysiology of and standard treatments for enuresis and discuss why standard treatments may fail. An interprofessional approach to treatment resistance is proposed which utilises the expertise of professionals from different disciplines to address the problems and barriers to treatment. The two interprofessional approaches include a multidisciplinary approach that involves the patient being sent to experts in different disciplines at different times to address their treatment resistance utilising the skills of the respective experts, and an interdisciplinary approach that involves a patient being managed by members of interdisciplinary team who integrate their separate discipline perspectives into a single treatment plan. Although an interdisciplinary approach is ideal, interdisciplinary teams may not be available in all circumstances. Understanding the roles of other disciplines and engaging clinicians from other disciplines when appropriate can still be helpful when treatment resistance is encountered.
Publisher: Oxford University Press
Date: 11-2013
Publisher: Springer Science and Business Media LLC
Date: 12-03-2015
Publisher: Springer International Publishing
Date: 2014
Publisher: Wiley
Date: 2018
DOI: 10.1111/JPC.13781
Publisher: Wiley
Date: 26-11-2015
DOI: 10.1111/JPC.13023
Abstract: This paper reviews the literature on the impact of social media on the health of children and young people. Relevant papers were identified from Medline, Embase and PsycINFO databases. The studies identified that the health impact of social media on children and young people was greatest on mental health and specifically in the areas of self-esteem and well-being, with related issues around cyberbullying and 'Facebook Depression', with an association between the use of social media and self-esteem and body image. However, it is difficult to determine the cause and effect, which is likely to be related to the nature of the young person. There is little work on the impact of social media on younger children. More research is needed to identify those most at risk of harm from social media and risk mitigation strategies to assist health-care professionals to provide essential education for parents and young people.
Publisher: Wiley
Date: 05-2016
DOI: 10.1111/JPC.13221
Publisher: Informa UK Limited
Date: 22-06-2022
DOI: 10.1080/10401334.2022.2084401
Abstract: Students, alongside teachers, play a key role in feedback. Student behavior in feedback processes may impact feedback outcomes. Student feedback behavior includes recognizing, seeking, evaluating, and utilizing feedback. Student feedback behavior is influenced by numerous student attributes and environmental factors. We aimed to explore influences on medical student feedback behavior during clinical attachments. We adopted a subjective inductive qualitative approach. We conducted 7 focus groups with 46 medical students undertaking pediatric hospital-based attachments. We based our discussion framework on existing characterizations of student feedback behavior and the educational alliance model with its focus on the relationship between learners and teachers, and the active role played by both. During initial data analysis, we identified that our results exhibited aspects of Bandura's model of Triadic Reciprocal Causation within Social Cognitive Theory. In line with our subjective inductive approach, we adopted Triadic Reciprocal Causation at this point for further analysis and interpretation. This allowed us to conceptualize the emerging interactions between influences on feedback behavior. We identified three key determinants of student feedback behavior:
Publisher: Wiley
Date: 23-08-2022
DOI: 10.1111/JPC.16176
Abstract: Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor-parent relationship. This qualitative study was conducted utilising semi-structured interviews with 17 paediatric physicians, surgeons, anaesthetists and trainees working in an Australian children's hospital. Data were analysed through deductive and inductive thematic analysis using line-by-line coding. Three key themes were identified: paediatricians' experiences with, and attitudes towards, parents using online health information paediatricians' communication approaches and the perceived impact on the doctor-parent relationship. These themes demonstrated that most paediatricians acknowledged the information parents found and directed parents to reliable websites. Following discussions with Internet-informed parents, a few changed their management plans and a few reported discouraging parents from further searching online. Our results indicate that paediatricians predominantly used patient-centred communication strategies to care for patients in partnership with parents. Paediatricians contextualising online health information can contribute to a quality partnership with parents and facilitate shared decision-making, potentially fostering better health outcomes for children. Our conclusions may inform clinicians' communication approaches when interacting with Internet-informed parents and stimulate research about more effective doctor-parent communication approaches. In a digital age, paediatricians may benefit from employing more time-efficient approaches to manage increasing workloads with their new role of digital stewardship of parents.
Publisher: Wiley
Date: 19-12-2022
DOI: 10.1111/JPC.16297
Abstract: Health literacy is the ability to understand and interpret health information and navigate the health‐care system. Low health literacy is associated with poorer health knowledge and disease management, increased chronic illness, underutilisation of preventative health services and increased hospitalisations. The aim of the study is to review the available literature on the relationship between parental health literacy and health outcomes for children with chronic disease in high‐income countries (HIC) and low‐ and middle‐income countries (LMIC). We systematically searched Medline, EMBASE and Web of Science, and assessed study quality using the Newcastle Ottawa Scale. We reviewed all relevant studies, and identified themes using thematic analysis. Of 1167 studies assessed, 49 were included in the review. All studies were of adequate quality. Twenty‐two were from LMIC and 27 from HIC. Six themes were identified: Parental health literacy, parental education, socio‐economic conditions, identity and culture, family factors, and health behaviours. In both HIC and LMIC, lower parental health literacy was associated with poorer child health outcomes. Disease‐specific knowledge was found in a number of papers to directly impact parent health behaviour and child health outcomes, and may mitigate the effects of low parental health literacy. There is a clear link between parental health literacy, health behaviour and health outcomes for children with chronic disease. Disease‐specific knowledge as a target for health‐care interventions holds promise for application in low‐resourced settings with parents (particularly mothers) who have lower health literacy, where disease‐specific education may improve child health outcomes, although more research is required to determine how we can best facilitate these programmes.
Start Date: 04-2020
End Date: 12-2024
Amount: $272,456.00
Funder: Australian Research Council
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